AB0987 Knee Reserve: ultrasonographic features of knees in patients with asymptomatic knee osteoarthritis
Authors: M. A. Mortada, Y. A. Amer
Journal: Annals of the Rheumatic Diseases (2022)

Background Symptoms of knee osteoarthritis (KOA) vary according to many factors mainly degree of KOA and degree of inflammatory features.The primary goal of treatment the patients with KOA is to maximize long-term health-related quality of life through control of symptoms. Understanding ultrasonographic characteristics of KOA in asymptomatic patients may help in management of knee osteoarthritis. Zagazig scale is a new validated and feasible tool for KOA assessment. Objectives To understand the ultrasonographic features of thepatients with asymptomatic knee osteoarthritis Methods Among 245 patients with knee OA diagnosed according to ACR criteria and recruited in a previous ultrasonographic study (1), data of patients with no or mild pain (VAS ≤ 2) was recorded and studied in a separate section. All patients were subjected to clinical assessment WOMAC scaleWestern Ontario and McMaster Universities Index of Osteoarthritis), global visual analogue scaleVAS, and functional assessment through the use of health assessment questionnaire-II (HAQ-II). Ultrasonographic assessment was conducted following ZAGAZIG scale comprising five domains: (1) Severity ofknee OA 6 grades (0-5) according to severity scale published by Mortadaet al 2016, (2) Effusion: 4 grades (0-3) no, mild moderate and severeeffusion respectively, (3) synovitis: 4 grades (0-3) using the combinedEULAR/OMERACT score of grey scale synovitis and Doppler activity, (4) Pes Anserine tendonitis /bursitis: 3 grades (0-2) normal, mild inflammation and severe inflammation (5) Baker cyst: 3 grades (0-2),grade0: normal no cyst, grade 1:small and simple cyst and grade 2: largeand/or complicated cyst. Each grade in all domains take one point in thescore with the total sore of all domains ranged from 0 to 15. Results At cut-off point of &gt;5, total US score distinguishes between knee osteoarthritis patients with no or mild pain87.2% sensitivity and 87.2% specificity. Table 1. Demonstrate demographic and ultrasonographic features of patients with KOA andVAS ≤ 2. Variables Age (47.9±7.1)33-58 Sex Females 32(71.2%) Males 13(28.8%) VAS (mean±SD) (1.7±0.5) HAQ-IImedian(mean±SD) 2(1.7±1.1) WOMAC pain subscale median(mean±SD) 1(0.62±1.1) WOMAC stiffness subscale median(mean±SD) 0(0.31±0.75) WOMAC function subscale median(mean±SD) 3(4.9±2.1) WOMAC Total scale median(mean±SD) 4(5.9±3.9) Osteophyte grades: 1 10(45.5%) 2 4(18.2%) 3 3(13.6%) 4 5(22.7%) 5 0(0.0%) Effusion 0 11(50.0%) 1 10(45.5%) 2 1(4.5%) Synovitis 0 15(68.2%) 1 6(27.3%) 2 1(4.5%) Baker cyst 0 22(100%) 1 0(0%) PesAnseinebursits 0 20(90.9%) 1 2(9.1%) Total score median(mean±SD) 3(3.9±2.4) 22 patients had no to mild pain according to Universal pain assessment, may have different combinations of wide range of degenerative changes (severity score (0-5) and inflammatory changes [effusion (0-3), synovitis (0-3), Pes Anserine (0-2) andBaker cyst (0-2)]but the total score of Zagazig scale ranged from 1 to 4. This may refer that patients can accommodate any combinations of degenerative and inflammatory changes with total score less than 5 on Zagazig scale with no or mild pain. Score less than 5 on Zagazig scale may consider as knee reserve in KOA. Conclusion The present study confirm that patients with KOA and asymptomatic or with mild pain may have awide range of degenerative changes and inflammatory changes. Score of less than 5on Zagazig scale are associated with no or mild pain. Score less than 5 may be considered as a marker of knee reserve in KOA. References [1]Mortada M, Dawa GA, Amer YA. Construct validity of a clinically correlated knee osteoarthritis ultrasonographic scale: a cross-sectional observational study. BMJ Open. 2021 Dec 14;11(12) Disclosure of Interests Mohammed A Mortada Speakers bureau: Novartis, Youmna A. Amer: None declared